Methods: PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2&nbsp;years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events.

Results: ACS patients with T2DM had higher PAPP-A (19.29&nbsp;&plusmn;&nbsp;16.36 vs. 13.29&nbsp;&plusmn;&nbsp;13.90&nbsp;ng/ml, p&nbsp;&lt;&nbsp;0.001) and higher rate of CV events 2&nbsp;years post ACS (27.2 vs. 13.6%, p&nbsp;=&nbsp;0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR&nbsp;=&nbsp;2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11&ndash;4.18, p&nbsp;&lt;&nbsp;0.001] in T2DM and (HR&nbsp;=&nbsp;3.16, 95% CI 2.27&ndash;4.39, p&nbsp;&lt;&nbsp;0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF&nbsp;&lt;&nbsp;50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model.

Conclusions: Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2&nbsp;years post ACS in patients with T2DM.

Fig3: Predictors of cardiovascular outcome 2 years post ACS. Receiver operating characteristics (ROC) curves for PAPP-A and other factors predicting cardiovascular outcome 2 years post ACS in a patients with T2DM; b patients without T2DM; and c all patients. Specifically, in ACS patients with T2DM, area under the ROC curve (AUC) was 0.79 for PAPP-A in brown color line, 0.69 for age in purple, 0.52 for LVEF in gold, 0.66 for GFR in blue, 0.64 for hsCRP in red, and 0.83 for all 5 factors combined in black

Mentions:
Areas under the ROC curves (AUC) for PAPP-A, age, LVEF, eGFR, hsCRP and the combination of all these predictors (from a multivariate logistic regression including all predictors) are shown in Fig. 3 and Table 4. Specifically, among subjects with T2DM (Fig. 3a), PAPP-A showed AUC of 0.79 (95% CI 0.70–0.87) which was significantly larger than LVEF (AUC 0.52; 95% CI 0.40–0.64; p < 0.001), eGFR (AUC 0.66; 95% CI 0.56–0.77; p = 0.03) and hsCRP (AUC 0.64; 95% CI 0.52–0.76; p = 0.01). Similar results were also seen in those without T2DM (Fig. 3b) and in all subjects (Fig. 3c).Fig. 3

Fig3: Predictors of cardiovascular outcome 2 years post ACS. Receiver operating characteristics (ROC) curves for PAPP-A and other factors predicting cardiovascular outcome 2 years post ACS in a patients with T2DM; b patients without T2DM; and c all patients. Specifically, in ACS patients with T2DM, area under the ROC curve (AUC) was 0.79 for PAPP-A in brown color line, 0.69 for age in purple, 0.52 for LVEF in gold, 0.66 for GFR in blue, 0.64 for hsCRP in red, and 0.83 for all 5 factors combined in black

Mentions:
Areas under the ROC curves (AUC) for PAPP-A, age, LVEF, eGFR, hsCRP and the combination of all these predictors (from a multivariate logistic regression including all predictors) are shown in Fig. 3 and Table 4. Specifically, among subjects with T2DM (Fig. 3a), PAPP-A showed AUC of 0.79 (95% CI 0.70–0.87) which was significantly larger than LVEF (AUC 0.52; 95% CI 0.40–0.64; p < 0.001), eGFR (AUC 0.66; 95% CI 0.56–0.77; p = 0.03) and hsCRP (AUC 0.64; 95% CI 0.52–0.76; p = 0.01). Similar results were also seen in those without T2DM (Fig. 3b) and in all subjects (Fig. 3c).Fig. 3

Methods: PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2&nbsp;years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events.

Results: ACS patients with T2DM had higher PAPP-A (19.29&nbsp;&plusmn;&nbsp;16.36 vs. 13.29&nbsp;&plusmn;&nbsp;13.90&nbsp;ng/ml, p&nbsp;&lt;&nbsp;0.001) and higher rate of CV events 2&nbsp;years post ACS (27.2 vs. 13.6%, p&nbsp;=&nbsp;0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR&nbsp;=&nbsp;2.97 for 1 SD increase in log10(PAPP-A), 95% CI 2.11&ndash;4.18, p&nbsp;&lt;&nbsp;0.001] in T2DM and (HR&nbsp;=&nbsp;3.16, 95% CI 2.27&ndash;4.39, p&nbsp;&lt;&nbsp;0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF&nbsp;&lt;&nbsp;50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model.

Conclusions: Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2&nbsp;years post ACS in patients with T2DM.